Jacqueline Lee Geddes, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

2366 Issued in OR

Practice address

11630 SE 40TH Ave
Suite a
Milwaukie, OR 97222-6195

Phone

(503) 739-5365

Fax

(971) 231-1420

NPI assigned

Jan 11, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Dr. Quillan Geddes Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475712000000",
    "number": "1700865490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11630 SE 40TH AVE",
            "address_2": "SUITE A",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972226195",
            "telephone_number": "503-739-5365",
            "fax_number": "971-231-1420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11630 SE 40TH AVE",
            "address_2": "SUITE A",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972226195",
            "telephone_number": "503-739-5365",
            "fax_number": "971-231-1420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GEDDES",
        "first_name": "JACQUELINE",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-01-11",
        "last_updated": "2016-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "PY00003673",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OR",
            "license": "2366",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMAP",
            "identifier": "50068100",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "QUILLAN",
            "last_name": "GEDDES",
            "prefix": "DR.",
            "credential": "PHD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Rebecca Yvonne Gauthier, CERTIFIED OCCUPATION
• Yvonne Sue Gavett, PTA
• Brandy Lynn Gayomali, LMT
• Melanie Meles Gebremariam
• Tedros Gebrezgabhere
• Angela E Geiger, MD
• Svetlana Gelman, M.A. CCC-SLP
• Frank Gemmato, LAC
• Genoa Healthcare LLC
• Andreana Marie-Concetta Gentile, DNP, FNP-C

• Psychologist in Milwaukie, OR
• Providers in Milwaukie, OR by specialty
• Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.